Erectile dysfunction Flashcards
What factors favour an organic cause?
gradual onset of sx
lack of tumescence - swollen engorged erection
normal libido
What factors favour a psychogenic cause?
sudden onset decreased libido good quality spontaneous or self stimulated erections major life events problems or changes in relationship prev psych problems HX of premature ejaculation
What are the RFs?
Increasing age
CVD: so obesity, DM, dyslipidaemia, metabolic syndrome, HTN, smoking
Alcohol
Drugs: SSRIs, BBs
What investigations should be done?
- Calcular 10 year CV risk: measure lipid and fasting glucose serum levels
- Free testosterone measured between 9 and 11am
What should be done if free testosterone is low or borderline=?
repeat and also do:
FSH
LH
Prolactin.
What is the management of ED?
- PDE-5 inhibitors - sildenafil, tadalafil
2. Lifestyle - lose weight, stop smoking etc, stop cycling loads lol
What is a low serum testosterone level ?
<12nmol/l
When should a pt be referred to urology?
young man who has always had difficulty achieving an erection
wHat are PDE5is also used for?
Pulmonary hypertension
How do PDE5is work?
smooth muscle relaxation in blood vessels supplying corpus cavernous
What are the CI of PDE5is?
- nitrates and related drugs e.g. nicorandil
- hypotension
- recent stroke or MI (wait 6 m)
What are SE of PDE5i?
- Visual disturbances: blue discolouration, non-arteritis anterior ischaemic neuropathy
- nasal congestion
- flushing
- GI SEs
- headache
- dizziness
What is priapism?
persistent penile erection lasting longer than 4 hrs
not associated w sexual stimulation
What causes ischaemic priapism?
impaired vasorelaxation -> reduced vascular outflow -> congestion and trapping of de-oxygenated blood in corpus cavernosa
What causes non-ischaemic priapism?
high arterial flow usually due to:
fistula formation as a result of congenital or traumatic mechanisms
